Healthcare Provider Details

I. General information

NPI: 1952400012
Provider Name (Legal Business Name): ERINE ALLISON KUPETSKY D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 02/17/2023
Certification Date: 02/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

638 LAWRENCEVILLE RD
LAWRENCEVILLE NJ
08648-4208
US

IV. Provider business mailing address

1 BECCA WAY
ALLENTOWN NJ
08501-2100
US

V. Phone/Fax

Practice location:
  • Phone: 609-337-7643
  • Fax:
Mailing address:
  • Phone: 609-947-3786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number5101017085
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: